Cone beam computed tomography analysis of maxillary vestibular bone thickness in the aesthetic region

Milica Djurdjević; Marija  Bubalo; Ana  Luković; Ana Igić; Aleksandar Acović; Tatjana Kanjevac

doi:10.2298/VSP221110032D

Milica Djurdjević University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry
Marija Bubalo Military Medical Academy, Dental Clinic, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Medical Military Academy, Belgrade, Serbia
Ana Luković University of Kragujevac, Faculty of Medical Sciences Department of Surgery, Kragujevac, Serbia
Ana Igić University of Niš, Faculty of Medicine, Preventive and Pediatric Dentistry, Niš, Serbia
Aleksandar Acović University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry
Tatjana Kanjevac Institute of Dentistry, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP221110032D

Keywords: alveolar bone loss, cone-beam computed tomography, dental implantation, maxilla, serbia

Abstract

Background/Aim. Insufficient buccal bone thickness (thickness less than 2 mm) frequently leads to fenestration and dehiscence, and their consequences are additional bone resorption. That represents an additional problem during implant placement. Cone beam computed tomography (CBCT) is becoming a priority in the diagnosis of bone thickness needed for implant placement since it has proven to be an accurate and largely reliable diagnostic tool in the image of morphology and buccal wall thickness. The aim of this study was to measure the vestibular bone thickness of the anterior maxillary region in the Serbian population and compare the difference between men and women, as well as between the left and right sides of the jaw. Methods. CBCT images of 68 patients were examined from the existing database. The length from the cementoenamel junction to the beginning of the alveolar bone was measured, followed by the thickness of the vestibular bone at various clinically relevant locations. The data were statistically processed and analyzed. Results. A total of 373 teeth of the frontal region of the upper jaw, including 128 central incisors, 124 lateral incisors, and 121 canines, were analyzed. The thickness of the buccal bone in more than 88% of cases was less than 1.5 mm at all reference points, with mean values from 0.72 to 1.02 mm. Conclusion. A very small number of maxillary teeth have a vestibular bone thickness greater than 2 mm; therefore, the criterion to provide at least 2 mm of thickness needed for implant placement is difficult to meet. That increases the use of auxiliary methods of bone augmentation during immediate implant placement

References

Trevizan M, Consolaro A. Premaxilla: an independent bone that can base therapeutics for middle third growth! Dental Press J Orthod 2017; 22(2): 21‒6.

Garib DG, Yatabe MS, Ozawa TO, da Silva Filho OG. Alveolar bone morphology under the perspective of the computed to-mography: Defining the biological limits of tooth movement. Dental Press J Orthod 2010; 15(5): 192‒205.

Sheerah H, Othman B, Jaafar A, Alsharif A. Alveolar bone plate measurements of maxillary anterior teeth: a retrospective cone beam computed tomography study, AlMadianh, Saudi Arabia. Saudi Dent J 2019; 31(4): 437‒44.

Morad G, Behnia H, Motamedian SR, Shahab S, Gholamin P, Khosraviani K, et al. Thickness of labial alveolar bone overlying healthy maxillary and mandibular anterior teeth. J Craniofac Surg 2014; 25(6): 1985‒91.

Naghibi N, Fatemi K, Hoseini-Zarch SH, Sadeghi B, Fasihi Ra-mandi M. CBCT evaluation of buccal bone thickness in the aesthetic zone of menopausal women: A cross-sectional study. Clin Exp Dent Res 2022; 8(5): 1076‒81.

London RM. The esthetic effects of implant platform selection. Compend Contin Educ Dent 2001; 22(8): 675‒82; quiz 683.

Zhou Z, Chen W, Shen M, Sun C, Li J, Chen N. Cone beam computed tomographic analyses of alveolar bone anatomy at the maxillary anterior region in Chinese adults. J Biomed Res 2014; 28(6): 498–505.

Zhang X, Li Y, Ge Z, Zhao H, Miao L, Pan Y. The dimension and morphology of alveolar bone at maxillary anterior teeth in periodontitis: a retrospective analysis-using CBCT. Int J Oral Sci 2020; 12(1): 4.

Becker W, Sennerby L, Bedrossian E, Becker BE, Lucchini JP. Im-plant stability measurements for implants placed at the time of extraction: a cohort, prospective clinical trial. J Periodontol 2005; 76(3): 391‒7.

Rangari P, Singh U, Singh N, Dewangan A. A Retrospective Study Evaluating the Anterior Bone Wall Thickness Using Cone Beam Computed Tomography Images with a Three Di-mensional Software. J Med Sci Clin Res 2018; 6(4): 849‒54.

Arango E, Plaza-Ruíz SP, Barrero I, Villegas C. Age differences in relation to bone thickness and length of the zygomatic pro-cess of the maxilla, infrazygomatic crest, and buccal shelf area. Am J Orthod Dentofacial Orthop 2022; 161(4): 510‒8. e1.

El Nahass H, N Naiem S. Analysis of the dimensions of the la-bial bone wall in the anterior maxilla: a cone-beam computed tomography study. Clin Oral Implants Res 2015; 26(4): e57‒61.

Al-Haj Husain A, Stadlinger B, Özcan M, Schönegg D, Winklhofer S, Al-Haj Husain N, et al. Buccal bone thickness assessment for immediate anterior dental implant planning: A pilot study comparing cone-beam computed tomography and 3D double-echo steady-state MRI. Clin Implant Dent Relat Res 2023; 25(1): 35‒45.

Venkatesh E, Elluru SV. Cone beam computed tomography: basics and applications in dentistry. J Istanb Univ Fac Dent 2017; 51(3 Suppl 1): S102‒21.

Khoury J, Ghosn N, Mokbel N, Naaman N. Buccal Bone Thick-ness Overlying Maxillary Anterior Teeth: A Clinical and Radi-ographic Prospective Human Study. Implant Dent 2016; 25(4): 525‒31.

Braut V, Bornstein MM, Belser U, Buser D. Thickness of the an-terior maxillary facial bone wall- a retrospective radiographic study using cone beam computed tomography. Int J Periodon-tics Restorative Dent 2011; 31(2): 125–31.

Vera C, De Kok IJ, Reinhold D, Limpiphipatanakorn P, Yap AK, Tyndall D, et al. Evaluation of buccal alveolar bone dimension of maxillary anterior and premolar teeth: a cone beam com-puted tomography investigation. Int J Oral Maxillofac Im-plants 2012; 27(6): 1514–9.

Chen ST, Darby I. The relationship between facial bone wall defects and dimensional alterations of the ridge following flap-less tooth extraction in the anterior maxilla. Clin Oral Im-plants Res 2017; 28(8): 931–7.

Kuchler U, Chappuis V, Gruber R, Lang NP, Salvi GE. Immedi-ate implant placement with simultaneous guided bone regen-eration in the esthetic zone: 10-year clinical and radiographic outcomes. Clin Oral Implants Res 2016; 27(2): 253–7.

Belser UC, Buser D, Hess D, Schmid B, Bernard JP, Lang NP. Aesthetic implant restorations in partially edentulous patients - a critical appraisal. Periodontol 2000 1998; 17: 132‒50.

Buser D, von Arx T. Surgical procedures in partially edentulous patients with ITI implants. Clin Oral Implants Res 2000; 11(Suppl 1): 83‒100.

Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992; 63(12): 995–6.

Choquet V, Hermans M, Adriaenssens P, Daelemans P, Tarnow DP, Malevez C. Clinical and radiographic evaluation of the pa-pilla level adjacent to single-tooth dental implants. A retro-spective study in the maxillary anterior region. J Periodontol 2001; 72(10): 1364‒71.

Ryser MR, Block MS, Mercante DE. Correlation of papilla to crestal bone levels around single tooth implants in immediate or delayed crown protocols. J Oral Maxillofac Surg 2005; 63(8): 1184–95.

Palmer RM, Farkondeh N, Palmer PJ, Wilson RF. Astra Tech single-tooth implants: an audit of patient satisfaction and soft tissue form. J Clin Periodontol 2007; 34(7): 633–8.

Lops D, Chiapasco M, Rossi A, Bressan E, Romeo E. Incidence of inter-proximal papilla between a tooth and an adjacent immediate implant placed into a fresh extraction socket: 1-year prospective study. Clin Oral Implants Res 2008; 19(11): 1135–40.

Le BT, Borzabadi-Farahani A. Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness. Implant Dent 2012; 21(5): 406‒10.

Langer B, Sullivan DY. Osseointegration: its impact on the in-terrelationship of periodontics and restorative dentistry. Part 3. Periodontal prosthesis redefined. Int J Periodontics Restor-ative Dent 1989; 9(4): 240–61.

Lee SL, Kim HJ, Son MK, Chung CH. Anthropometric analysis of maxillary anterior buccal bone of Korean adults using cone-beam CT. J Adv Prosthodont 2010; 2(3): 92‒6.

Nowzari H, Molayem S, Chiu CH, Rich SK. Cone beam comput-ed tomographic measurement of maxillary central incisors to determine prevalence of facial alveolar bone width ≥2 mm. Clin Implant Dent Relat Res 2012; 14(4): 595‒602.

Fuentes R, Flores T, Navarro P, Salamanca C, Beltrán V, Borie E. Assessment of buccal bone thickness of aesthetic maxillary re-gion: a cone-beam computed tomography study. J Periodontal Implant Sci 2015; 45(5): 162‒8.

Ghassemian M, Nowzari N, Lajolo C, Verdugo F, Pirronti T, D'Addona A. The thickness of facial alveolar bone overlying healthy maxillary anterior teeth. J. Periodontol 2012; 83(2): 187–97.

Belser U, Martin W, Jung R, Hämmerle C, Schmid B, Morton D, et al. Implant therapy in the esthetic zone: single-tooth re-placements. In: Buser D, Belser U, Wismeijer D, editors. ITI Treatment Guide Series, Volume 1. Berlin (DE): Quintessence Publishing Co. Ltd.; 2006. p. 268.

Boskey AL, Coleman R. Aging and bone. J Dent Res 2010; 89(12): 1333–48.

Kelly PJ, Twomey L, Sambrook PN, Eisman JA. Sex differences in peak adult bone mineral density. J Bone Miner Res 1990; 5(11): 1169–75.

Farahamnd A, Sarlati F, Eslami S, Ghassemian M, Youssefi N, Jafarzadeh Esfahani B. Evaluation of Impacting Factors on Fa-cial Bone Thickness in the Anterior Maxillary Region. J Crani-ofac Surg 2017; 28(3): 700‒5.

Zekry A, Wang R, Chau AC, Lang NP. Facial alveolar bone wall width - a cone-beam computed tomography study in Asians. Clin Oral Implants Res 2014; 25(2): 194‒206.

Behnia H, Motamedian SR, Kiani MT, Morad G, Khojasteh A. Ac-curacy and reliability of cone beam computed tomographic measurements of the bone labial and palatal to the maxillary anterior teeth. Int J Oral Maxillofac Implants 2015; 30(6): 1249‒55.